Symphysis Pubis Dysfunction or Pelvic Girdle Pain is a common reason women visit an Osteopath during pregnancy and sometimes after pregnancy. Beginning from as early as the first trimester, however more commonly from around 20 weeks onwards, SPD creates a distinctive pain in the pubis at the front of the pelvis often with pain also felt through the back of the pelvis and radiation into the hips, thighs, lower back and abdomen. Women typically find this pain to be at its worst when they are standing, especially on one leg such as when getting dressed, or when separating the knees such as when turning in bed, getting into and out of the car, walking with long strides, swimming breaststroke or having sex.
The hormone relaxin is often blamed almost exclusively for SPD, however research is quite inconclusive with 3 out of 4 high quality studies included in a 2012 systematic review finding no association between relaxin levels and pregnancy related pelvic pain. This leaves us with the question of – if relaxin is potentially less of a factor that typically thought, what really is going on?
Pregnancy places a huge strain on the body in many ways, with great changes in the physiology and functioning of the whole body. The musculoskeletal system is not immune to these changes. Small functional restrictions that the body as a whole was able to cope with quite readily prior to pregnancy become potential sites of pain.
Osteopathically, the most significant function of the body is movement. I like to explain it as the human body has a certain amount of movement it considers ideal at each joint within the body. some move a lot, some move very little, but every joint has the capacity for some movement. Within the axial skeleton, the lower back (lumbar) and neck (cervical) regions move relatively a lot, the upper back (thoracic) significantly less, and the joints between the spine and the pelvis and within the pelvic ring, very little at all. Ideally, the day we are born we have perfect movement at each of these joints, though sadly that’s not often the case, and that’s a topic for another day. Over the course of our lives we bump, slouch, crash, twist and jolt our bodies many thousands of times, many without ever really considering it an ‘incident’. We go through childhood bouncing around like kids do, we spend our school years carrying increasingly heavy loads on our backs and spending increasing amounts of time sitting in front of a desk. We then join the workforce where we typically do one activity repetitively, whether that’s more sitting at a desk, manual labour or driving or … well you get the picture. All of these factors ever so steadily use up our body’s ability to compensate for the little restrictions that build up in our body. That slip when you fell on your backside in the big freeze might have created a restriction through your sacroiliac joint between your spine and your pelvis, or perhaps a restriction in the lumbar spine. The fatigue you feel in your thoracic spine and neck when sitting in your desk chair each day at work coupled with a minor prang in the car several years back might be representative of restrictions through the thoracic spine and the musculature associated with the entire shoulder girdle, which of course, given the human body’s love of sharing it’s woes around, begins to affect the muscles headed up into the neck. These are just two examples of the simple things we do to ourselves day in and day out. Usually we get ourselves out for a good walk, maybe do some stretches or have a hot shower and a good sleep and we feel pretty close to functional again to battle on the next day. Ultimately the body compensates for joints with restricted movement by increasing the movement in other joints and regions. Everything seems pretty hunky dory.
Then pregnancy happens and we can’t quite fathom why our body suddenly begins screaming at us.
One of the most common factors in pelvic girdle pain in general, but in pregnancy in particular, in my experience is that the sacroiliac joints and the pubic symphysis are joints which aren’t designed to move very much at all. They are also joints which don’t have any muscles directly supporting them, so once ligaments begin to be hit with the effects of relaxin, they are prime candidates for strain when related areas of the body aren’t moving the way they ideally should be. This makes treatment of pelvic girdle pain often quite simple. Get the restrictions elsewhere moving and the body is no longer forced to seek extra movement through these little joints which aren’t designed to be moving a whole lot. Often, simply balancing the pelvis and getting the thoracic spine moving is sufficient to get a woman out of pain. Naturally the body, being the wondrous complex marvel that it is, doesn’t always make things so simple, however this simple case serves to demonstrate how Osteopathy seeks to help return the body to a state where the pains related to the strains and stresses of pregnancy can be significantly reduced or removed.
If you have any questions with regards how I can help you to enjoy your pregnancy as much as possible don’t hesitate to contact me.